June 29, 2023 – What should ulcerative colitis patients know about cholesterol management?
It’s estimated that 200 out of every 100,000 Americans have ulcerative colitis, or UC. And that's a figure that’s doubled over 2 recent decades. UC is an inflammatory bowel disease (IBD). The condition occurs in the innermost lining of the colon and rectum, causing sores inside your digestive tract. UC can alternate between flare-ups and periods of remission.
UC patients not only have to deal with treating and managing digestive problems related to their IBD – they’re also at higher risk for cardiovascular disease. This risk exists even though UC patients tend to have lower cholesterol levels than patients thought to be “traditionally” at risk of heart attacks and strokes.
A new study from researchers in the Netherlands found that IBD patients’ cardiovascular risk factors may be underestimated because of the absence of things like high cholesterol.
“Patients with IBD show lower levels of total cholesterol, HDL-c and LDL-c, as compared to the general population,” said study co-author Jasmijn Sleutjes, MD, researcher in the Department of Gastroenterology and Hepatology at Erasmus University Medical Center in Rotterdam. “This observation is more clearly seen in patients with active disease. It’s referred to as the so-called ‘lipid paradox’ – the reverse correlation between lipid levels and inflammatory markers.”
A recent multi-university study found that UC patients also face an increased risk of heart failure, although why that is isn't clear yet.
The lipid paradox could be a possible reason, “said study co-author Chayakrit Krittanawong, MD, a cardiologist practicing in New York City.
“We need more data on this, particularly prospective clinical trials," he said.
Lower cholesterol levels aren’t directly caused by UC itself. Rather, the reason people with UC often don’t have high cholesterol has to do with how debilitating the condition can be.
“Patients with active ulcerative colitis may lose weight from limiting their food intake due to their bowel symptoms, and this may in turn lead to lower cholesterol levels,” said David T. Rubin, MD, a professor of medicine at the University of Chicago and chair of the Crohn’s & Colitis Foundation National Scientific Advisory Committee.
For UC patients, it's important to manage the inflammatory bowel disease while also keeping cholesterol in a healthy range.
What are the Symptoms of Ulcerative Colitis?
According to the Crohn’s and Colitis Foundation, signs of UC can include:
- Urgently needing to have a bowel movement
- Loose stools
- Bloody stools
- Stomach cramps or pain in your belly
- Chronic diarrhea
The severity of UC symptoms can vary from person to person. Some people only have mild problems, while for other people, UC can have a serious impact on quality of life.
What Are the Symptoms of Heart Disease and Stroke?
The CDC says symptoms of heart disease vary by specific condition.
Symptoms of a heart attack include pain or discomfort in the chest, upper back, or neck, plus nausea, vomiting, intense tiredness, feeling dizzy, or feeling short of breath. Heart failure signs include shortness of breath, extreme fatigue, or swelling of the legs, feet, ankles, stomach, or the veins in the neck.
Signs of a stroke come on abruptly, the CDC says. They include numbness or weakness in the face, arm, or leg, notably on one side of the body; confusion; a hard time speaking; vision problems in one or both eyes; trouble walking, or losing balance or coordination; and a bad headache.
If you have any of these symptoms, get medical help right away
Why Are UC Patients at Higher Risk for Cardiovascular Disease?
New research from the University of California, Riverside, found that IBD patients may have fewer antimicrobial cells that protect the body against E. coli bacteria. A form of E. coli called adherent-invasive (AIEC) then can increase in IBD and make inflammation worse.
Research has previously pointed to the fact that during flare-ups, IBD patients have triple the risk of blood clots that can lead to a heart attack or stroke. This is thought to be because of increased inflammation in the body while IBD symptoms are present.
“Increased cardiovascular disease risk in IBD is most likely related to a patient’s chronic inflammatory burden, which also plays a role in the stepwise development of atherosclerosis,” Sleutjes said.
What Treatment Options Can Help With UC, And How Do They Affect Cholesterol?
Interestingly, even though UC patients tend to have lower cholesterol, statin therapy – drugs used to treat high cholesterol – have shown promise in preventing UC. And a Stanford University study found that statins taken by UC patients can also lower their chances of needing colon surgery by as much as 50%. UC patients may also see fewer symptoms by using statins, because the drugs reduce gene activity patterns in UC itself.
Two other drugs, tofacitinib and upadacitinib, may also help treat moderate to severe UC. These drugs can actually raise a patient’s cholesterol. (Of note, two of the newer therapies for treating moderate to severe UC affect cholesterol levels.)
“Cholesterol in about 20 [to] 30% of people will go up by about 10%,” explained Rubin. "However, this may be transient. HDL – ’good cholesterol’ – and LDL – ’bad cholesterol’ – rise at the same time. We usually do not treat this change in cholesterol.”
People who have symptoms of UC, or a diagnosis, should work with their doctor to find the right treatment option. Also, getting regular cholesterol checks, due to the fluctuations therapy can cause, is important.
“There are no specific guidelines for ulcerative colitis management that recommend checking cholesterol, but the U.S. Preventive Services Task Force does recommend that adults know their cholesterol, given its known association with atherosclerotic disease,” said Rubin.
Focus on your diet with your doctor to reduce UC symptoms, stay on top of your nutrition, and make sure your cholesterol stays in a healthy range. The Crohn’s and Colitis Foundation has guides to get you started. You can stay in control of your health – and feel better.